A Case of Huge Ascending Aortic Aneurysm with Wall Calcification

Although ascending aortic aneurysm is a uncommon disease, it has fatal complications such as aortic rupture, dissection, or death. So, experts recommend a preemptive aortic operation. A 77-year-old man with hypertension visited for slow progressive exertional dyspnea and general weakness. Chest X-ray showed deviation of trachea to right, mediastinal widening, cardiomegaly, and bulging of right heart border to right. Transthoracic echocardiography(TTE) and transesophageal echocardiography(TEE) showed marked dilated ascending aorta with wall calcification associated with severe aortic regurgitation and pericardial effusion. Measured diameter of ascending aorta was 12 x 11 cm on Chest Computed Tomography (CT) scan, 8.35 cm on TTE, and 10.2 cm on TEE. Our exam found out the obstructive pneumonia and aortic regurgitation as consequences of complications of huge aneurysm. We report a case of huge ascending aortic aneurysm without any previous aortic operation, aortic complications, trauma, or other etiologic factors.

CT and angiographic findings in ruptured intracranial aneurysms

CT has become the most useful, non-invasive diagnostic method as the initial exmination in the diagnosis ofruptured intracranial aneurysm with intracranial hemorrhage(subarachnoid, intracerebral and intraventricularhemorrhage), hydrocephalus and infarction. Furthermore, high resolution CT can demonstrate aneurysm itself. Butangiography is the last and conclusive method as yet, for better evaluation of vascular anatomic structure ofaneurysm for surgery. Authors analyzed 40 cases of ruptured intracranial aneurysm confirmed by CT, angiographyand/or surgery at Chonnam National University Hospital from July, 83' to July, 85'. The results were as follows:1. The most prevalent age group was the 5th decade(35%), and female patient(57.5%) was more comon than male. 2.Angiographic findings were as follows: 1) Multiple aneurysm was found in 8 patients (20%): the one of thesepatients is tripple, the others are double. 2) The location of aneurysm, in order ot frequency, were : ACA andA-com aneurysm in 23 cases(47%). ICA and P-com aneurysm in 17 cases(35%), basilar tip aneurysm in 4 cases(8%), MCAaneurysm in 3 cases(6%) and PCA aneurysm in 1 case(2%). 3) Hydrocephalus was detected in 22 cases (55%): 21 cases(95%) of these cases were demonstarated within the first 3 weeks after attack. 4) Detection of aneurysm itseslfwas 20 cases(50%). 5) Cerebral infarction was 5 cases(12.5%). 6) Subarachnoid enhancement on post-contrast scanwas 8 cases(20%).

Percutaneous Antegrade Pyelography

Percutaneous antegrade pyelography guided by ultrasonography and fluoroscopy was attempted in 25 patients with supravesical obstructive hydronephrosis and suctessful in 23 patients to evaluate the site and nature of urinary obstruction. The etiology of the obstructive uropathies were urinary stricture in 11 cases,urinary Tbc. in 5 cases, urinary stone in 3 cases, uterine prolapse with cystocele, pyonephrosis, ureteral metastatic testicular carcinoma in 1 case respectively. No significant complication of the percutaneous antegrade pyelography was observed. Percutaneous antegrade pyelography provides significant diagnostic informations on the obstructive lesion and can be accomplished with ease and safe in patients with obstructiv hydronephnosis as a diagnostic procedure of choice in infants and children or as an alternative to a retrograde pyelography.